Finland is showing the way for European health examination surveys

The first population health examination surveys in Finland were conducted as early as in the 1950s and 1960s. Pioneering projects, such as the East-West study and the Finnish Mobile Clinic Health Examination Survey, not only interviewed the participants but also measured and weighed their health status objectively. This was the start of Europe’s longest tradition of health examination surveys in Finland. Since that time, the tradition has been carried on in the form of such surveys as FINRISK, Mini Finland, Health 2000, Health 2011 and the Migrant Health and Well-being Survey.

The field work stage of the latest survey to examine the health status of the adult population across mainland Finland will be concluded this June.

Health examination surveys are an important part of the national health information system together with data in administrative registers such as the Care Register for Health Care and the Causes of Death Register, as well as information obtained through health interview surveys, including the Regional Health and Well-being Study.

Health examination surveys produce measured data on health status and functional capacity that is not available from other sources. For example, surveys or registers cannot tell us what proportion of the Finnish population has a elevated blood pressure and how many are receiving treatment for it, let alone the number of cases in which the treatment has worked, bringing the patient’s blood pressure readings down to recommended levels.

Health comparisons between EU Member States

As late as in the 1970s, Finland was the only European country to carry out regular and extensive health examination surveys on the health status of its population. Elsewhere in Europe, the studies were small-scale regional surveys. The WHO MONICA and CINDI projects, for example, focused on risk factors of cardiovascular diseases, including smoking, high blood pressure and cholesterol as well as obesity.

As we reached the 1990s, Germany, Italy, the Netherlands and the United Kingdom gradually saw the need to carry out their own national surveys. And at the dawn of the new millennium, a large number of countries joined these pioneers and began collecting objective, measurement-based data on their population’s health status and risk factors.

Up to date, one half of the EU Member States have implemented at least one national health examination survey. Many countries, including Finland, the United Kingdom, Germany, Poland and Italy carry them out repeatedly, and new countries are joining their ranks constantly.

Since the early 2000s, the European Commission’s DG Health and Food Safety (DG SANTÉ) has been intent on setting up a European system of national health examination surveys. EU Member States and especially the Commission are also interested in comparing health indicators between countries. Comparisons are only possible, however, if the countries’ surveys are conducted using the agreed standard methodology.

This will help to bring up genuine differences in health and risk factors between Member States, rather than discrepancies due to the measurement techniques. Earlier studies have shown significant variations in the prevalence of such risk factors as smoking and obesity in Europe. For example, WHO’s Health for All Database indicates that the prevalence of smoking varies from approx. 10% to almost 50% of those aged 15 and over. Similarly, obesity rates in those aged 18 and over vary from 15% to 30%.

Finnish expertise is in demand

Finland’s long experience of health studies has put us centre stage in efforts to develop a European system of health examination surveys. The National Institute for Health and Welfare has led several EU projects relevant to this topic over the last 20 years. The most recent one has been the piloting of the European Health Examination Survey and EHES coordination since 2009. The Institute has participated in developing European standards and guidelines for health examination surveys and training survey organisers in different countries.

At the EU level, an EU health information system is currently being planned, in which the health examination surveys would be one source of information. The National Institute for Health and Welfare is involved in planning the European Research Infrastructure (ERIC) to be set up for this purpose. In addition, an extensive EU project on human biomonitoring (HBM4EU) will also rely on the Institute’s expertise in health examination surveys.